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Dermatologic Manifestations of Lymphogranuloma Venereum Treatment & Management

  • Author: Jose A Plaza, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Oct 20, 2015
 

Medical Care

The treatment of choice for lymphogranuloma venereum (LGV) is doxycycline (100 mg orally bid for 21 d).[12] Although azithromycin is effective against other chlamydial strains and may prove to be effective against infection with LGV serovars, no controlled treatment trials support the use of azithromycin treatment for LGV. Incision and drainage may result in nonhealing fistula formation, which can be minimized by draining involved lymph nodes from above the inguinal ligament. Symptomatic treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and local heat for pain relief may be useful adjuncts.

Immunocompromised persons, such as those with HIV infection, should receive the same treatment as immunocompetent persons; however, given the lack of data, patients with HIV infection and other immunocompromising conditions should be followed closely to assess resolution of symptoms.[13]

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Surgical Care

Surgery often is necessary for repair of late lymphogranuloma venereum (LGV) complications such as fistulas and strictures.

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Consultations

Surgical consultation for lymphadenopathy is generally not required unless extensive buboes require further exploration. For tertiary disease, appropriate surgical consultation is indicated.

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Contributor Information and Disclosures
Author

Jose A Plaza, MD Director of Dermatopathology, Department of Pathology, Froedtert Hospital; Assistant Professor, Department of Pathology, Section of Dermatopathology, Medical College of Wisconsin

Jose A Plaza, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

Victor G Prieto, MD, PhD Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center

Victor G Prieto, MD, PhD is a member of the following medical societies: American Society of Dermatopathology, College of American Pathologists, American Association for the Advancement of Science, International Society of Dermatopathology, European Society of Pathology, American Medical Association, American Society for Clinical Pathology, Society for Investigative Dermatology, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jennifer D. Lorek, MD, Scott M. Acker, MD, Peter Langenstroer, MD, and Milton W. Datta, MD, to the development and writing of this article.

References
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  2. Herida M, de Barbeyrac B, Sednaoui P, et al. Rectal lymphogranuloma venereum surveillance in France 2004-2005. Euro Surveill. 2006 Sep. 11(9):155-6. [Medline].

  3. Kapoor S. Re-emergence of lymphogranuloma venereum. J Eur Acad Dermatol Venereol. 2008 Apr. 22(4):409-16. [Medline].

  4. Klint M, Lofdahl M, Ek C, Airell A, Berglund T, Herrmann B. Lymphogranuloma venereum prevalence in Sweden among men who have sex with men and characterization of Chlamydia trachomatis ompA genotypes. J Clin Microbiol. 2006 Nov. 44(11):4066-71. [Medline].

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  7. Rönn MM, Ward H. The association between lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis. 2011 Mar 18. 11:70. [Medline]. [Full Text].

  8. Thappa DM, Sivaranjini R. Venereology in India. Indian J Dermatol. 2011 Jul. 56(4):363-7. [Medline]. [Full Text].

  9. Chen CY, Chi KH, Alexander S, et al. The molecular diagnosis of lymphogranuloma venereum: evaluation of a real-time multiplex polymerase chain reaction test using rectal and urethral specimens. Sex Transm Dis. 2007 Jul. 34(7):451-5. [Medline].

  10. Hadfield TL, Lamy Y, Wear DJ. Demonstration of Chlamydia trachomatis in inguinal lymphadenitis of lymphogranuloma venereum: a light microscopy, electron microscopy and polymerase chain reaction study. Mod Pathol. 1995 Dec. 8(9):924-9. [Medline].

  11. Klotz SA, Drutz DJ, Tam MR, Reed KH. Hemorrhagic proctitis due to lymphogranuloma venereum serogroup L2. Diagnosis by fluorescent monoclonal antibody. N Engl J Med. 1983 Jun 30. 308(26):1563-5. [Medline].

  12. [Guideline] Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline].

  13. Gilleece Y, Sullivan A. Management of sexually transmitted infections in HIV positive individuals. Curr Opin Infect Dis. 2005 Feb. 18(1):43-7. [Medline].

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